Category Archives: Treatment

As Demand For Mental Health Care Continues: Technology May Be An Important Answer

Although the COVID-19 pandemic has eased, the demand for mental health care continues to persist.

A newly published 2022 COVID-19 Practitioner Impact survey by the American Psychological Association of U.S. psychologists reports that a growing demand for help with depression, anxiety and substance use issues means many psychologists across the United States are unable to take on new patients.

Over 2,200 licensed psychologists nationwide responded to the APA’s third annual practitioner survey in late September and early October. About 60% said they no longer can take on new patients and 72% said they have longer waitlists than before the pandemic. On average, psychologists said 15 people a week contact them seeking new care.

The survey reported that 79% said they have seen more patients with anxiety disorders since the pandemic began. approximately 66% have seen increased demand for depression treatment; 47% for substance use treatment, and 64% for trauma. About two-thirds of psychologists described the patients’ symptoms as being more severe this year.

Young people, especially 13- to 17-year-olds, represented the largest increases in seeking care. Many psychologists also saw a need for more care in children under 13 and among 18- to 25-year-olds.

Nearly half of psychologists reported a rising number of health care workers seeking treatment since the start of the pandemic. According to Arthur Evans Jr., chief executive officer of the APA, “Having timely access to psychological services is critical for addressing the needs of those diagnosed with behavioral health challenges,” Evans said in an association news release. “But we need to tackle this problem with a variety of solutions, beyond individual therapy.”

He cited the need to support and expand the psychologist workforce; to integrate behavioral health into primary care, and use technology and innovation to reach more patients.

About 11% of psychologists now see all patients in person, up from 4% in 2021. More than half (58%) see some patients remotely and some in person. About 31% see all patients via telehealth.

The APA noted that telehealth can expand access to care for patients from underserved communities, including those in rural areas and people of color. The APA continues to advocate for expanded coverage of telehealth by insurance companies.

With the high patient demand, about 45% of psychologists said they feel burned out. But 60% said they have sought peer consultation or support to manage it. About 77% said they were able to practice self-care and 63% said they have been able to maintain a positive work-life balance.

APA Survey Link

World Mental Health Day – October 10, 2022

Monday, October 10th, is the annual World Mental Health Day as designated by the World Health Organization (WHO). The theme this year is “Making Mental Health and Well-Being for All a Global Priority,” and for everyone to be a voice about what needs to be done to promote, de-stigmafy, and facilitate the availability and delivery of mental health treatment.

Can Technology Help?

According to the National Institute of Mental Health, “technology has opened a new frontier in mental health support and data collection. Mobile devices like cell phones, smartphones, and tablets are giving the public, doctors, and researchers new ways to access help, monitor progress, and increase understanding of mental wellbeing.”

Mobile technology can help to facilitate access to treatment and support. For example, anyone with the ability to send a text message can contact a crisis center. New technology can also be packaged into an extremely sophisticated app for smartphones or tablets. Such apps might use the device’s built-in sensors to collect information on a user’s typical behavior patterns. If the app detects a change in behavior, it may provide a signal that help is needed before a crisis occurs. Some apps are stand-alone programs that promise to improve memory or thinking skills. Others help the user connect to a peer counselor or to a health care professional.

App development has generated a great deal of enthusiasm and possibilities However, there are thousands of mental health apps available for smartphones, and the number is growing every year. However, this new technology frontier includes a lot of uncertainty. There is very little industry regulation and very little information on app effectiveness, which can lead consumers to wonder which apps they should trust.

The NIMH Highlights A Number of Pros and Cons of Mental Health Apps

Experts believe that technology has a lot of potential for clients and clinicians alike. A few of the advantages of mobile care include:

  • Convenience: Treatment can take place anytime and anywhere (e.g., at home in the middle of the night or on a bus on the way to work) and may be ideal for those who have trouble with in-person appointments.
  • Anonymity: Clients can seek treatment options without involving other people.
  • An introduction to care: Technology may be a good first step for those who have avoided mental health care in the past.
  • Lower cost: Some apps are free or cost less than traditional care.
  • Service to more people: Technology can help mental health providers offer treatment to people in remote areas or to many people in times of sudden need (e.g., following a natural disaster or terror attack).
  • Interest: Some technologies might be more appealing than traditional treatment methods, which may encourage clients to continue therapy.
  • 24-hour service: Technology can provide round-the-clock monitoring or intervention support.
  • Consistency: Technology can offer the same treatment program to all users.
  • Support: Technology can complement traditional therapy by extending an in-person session, reinforcing new skills, and providing support and monitoring.
  • Objective data collection: Technology can quantitatively collect information such as location, movement, phone use, and other information.

This new era of mental health technology offers great opportunities but also raises a number of concerns. Tackling potential problems will be an important part of making sure new apps provide benefits without causing harm. That is why the mental health community and software developers are focusing on:

  • Effectiveness: The biggest concern with technological interventions is obtaining scientific evidence that they work and that they work as well as traditional methods.
  • For whom and for what: Another concern is understanding if apps work for all people and for all mental health conditions.
  • Privacy: Apps deal with very sensitive personal information so app makers need to be able to guarantee privacy for app users.
  • Guidance: There are no industry-wide standards to help consumers know if an app or other mobile technology is proven effective.
  • Regulation: The question of who will or should regulate mental health technology and the data it generates needs to be answered.
  • Overselling: There is some concern that if an app or program promises more than it delivers, consumers may turn away from other, more effective therapies.

Currently, there are no national standards for evaluating the effectiveness of the hundreds of mental health apps that are available. Unfortunately, most apps do not have peer-reviewed research to support their claims, and it is unlikely that every mental health app will go through a randomized, controlled research trial to test effectiveness. Consumers should be cautious about trusting a program.

NIMH offers some suggestions recommended to consumers when considering using a ‘mental health’ app.

  • Ask a trusted health care provider for a recommendation. Some larger providers may offer several apps and collect data on their use.
  • Check to see if the app offers recommendations for what to do if symptoms get worse or if there is a psychiatric emergency.
  • Decide if you want an app that is completely automated or an app that offers opportunities for contact with a trained person.
  • Search for information on the app developer. Can you find helpful information about his or her credentials and experience? 
  • Beware of misleading logos. The National Institute of Mental Health (NIMH) has not developed and does not endorse any apps. However, some app developers have unlawfully used the NIMH logo to market their products.
  • Search the PubMed database offered by National Library of Medicine. This resource contains articles on a wide range of research topics, including mental health app development.
  • If there is no information about a particular app, check to see if it is based on a treatment that has been tested. For example, research has shown that Internet-based cognitive behavior therapy (CBT) is as effective as conventional CBT for disorders that respond well to CBT, like depression, anxiety, social phobia, and panic disorder.
  • Try it. If you’re interested in an app, test it for a few days and decide if it’s easy to use, holds your attention, and if you want to continue using it. An app is only effective if keeps users engaged for weeks or months.

It is clear that mental health needs more attention in the United States, as indicated by the recent polls about our deteriorating mental health. A new survey indicates that 90% of adults believe that there is a mental health crisis.1 A very recent poll by the American Psychiatric Association conveys that almost 80% agree that more attention to mental health by lawmakers is needed.2

  1. CNN Health/Kaiser Foundation. 90% of US adults say the United States is experiencing a mental health crisis
  2. Americans Believe Mental Health Is a Public Health Emergency That Needs More Attention from Lawmakers.

Tech News Briefs – 9/12/22


Various recent technology news / studies that may be of interest.


Study examines the impact of fake online reviews on sales
New research exposes the pervasive practice of fake online product reviews

Can you really trust that online product review before you make a purchase decision? New research has found that the practice of faking online product reviews may be more pervasive than you think.

According to researchers from UCLA Anderson School of Management, andthe Marshall School of Business at the University of Southern California (USC), a wide array of product marketers actually purchases fake online reviews through an online marketplace found through social media. As a result, marketers receive many reviews and high-average ratings on e-commerce sites that include Amazon, Walmart and Wayfair, among others.

The study, published in the current issue of the INFORMS journal Marketing Science, offers:

Key Takeaways:

  • There’s a large online marketplace for the selling and buying of fake online reviews.
  • Fake online reviews do contribute to better ratings and sales for product sellers.
  • Most major brands do not engage in the practice of buying fake reviews.
  • Online marketplaces work to regulate online fake reviews, but there is lag time in enforcement.

[Read more]


Noble Introduces Mental Health Technology To Reduce Misdiagnosed And Underserved Patients In Primary Care

Noble is an AI, and objective data-driven mental health app, announced the launch of a new offering for primary care physicians and mental health professionals that provides remotely monitored, preventative, and early intervention support for acute or chronic mental health conditions.

According to the app creators, it consists of four-part remote patient monitoring model combines innovative technology with trained mental health professionals to impact outcomes in a lasting, meaningful way:

  • Assess: Subjective data gathering through client self-reporting and objective data gathering through hair cortisol concentration tests, heart rate variability (HRV), and voice as a digital biomarker.
  • Support: AI-driven care provider dashboard that shares the remotely monitored objective data stream to offer remote insights and real-time alerts to the care provider and team.
  • Motivate: Immediate, AI-driven treatment, protocol-driven and therapeutic interventions based on patient needs.
  • Connect: Human-to-human monitoring and coaching support guided by additional understanding through voice analysis, and AI-supported technology.

[Read more]


Magnus Medical announced today that it received FDA 510(k) clearance for its Saint neuromodulation system. 

The Saint neurostimulation platform is for the treatment of major depressive disorder (MDD). It treats adults who fail to achieve satisfactory improvement from prior antidepressant medications in the current episode.

The individualized, rapid-acting, non-invasive neurostimulation platform demonstrated the potential to be a reproducible, rapid and highly effective treatment for severe, refractory depression in a broader clinical setting. It received FDA breakthrough device designation in October 2021.

Saint combines advanced imaging technologies and personalized targeting and novel stimulation patterns. It uses structural and functional MRI to inform a proprietary algorithm. The algorithm identifies the optimal anatomic target for focused neurostimulation in people with MDD.

Results of a trial published in the American Journal of Psychiatry showed that 79% of people in the active treatment arm entered remission from their depression. That compared to 13% in the sham treatment arm. Magnus said in a news release that the new “individualized” neurostimulation provides a new option for treating depression.

[Read more]


App for serious mental illness starts clinic-training phase

The Patient-Centered Outcomes Research Institute (PCORI) announced funding ($1.8 million) to bring a mental health smartphone app into real world practice. The app is called FOCUS, which has shown promise as a supportive therapy for people who have serious mental illness such as schizophrenia and bipolar disorder. 

The development team,headed by Dror Ben-Zeev, Ph.D. a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, have guided the app’s development through early user studies, the most recent of which showed that patients found the digital therapy more engaging than a scheduled trip to the clinic — the far more resource-intensive conventional care.

The next step for FOCUS involves rolling out a system aimed at teaching clinicians how to engage patients to use the app confidently and how to get the most information from patients’ use.

“We demonstrated that FOCUS is clinically potent in several studies, but to move this from academic research to real-world practice, we need an implementation approach that includes digital trainings for clinicians who are not used to mental health apps. This will support their journey as digital health adopters, which is a daunting task for some. We’re creating evergreen materials so any clinician will be able to get FOCUS up and running with their patients quickly,” Ben-Zeev said.

Part of the study is to understand how different clinic staff might need different information upfront about FOCUS to introduce it in a compelling way to their colleagues.

“It could be frontline clinicians or admin support people or team leaders, so we need to ensure that we finely tune the information that helps FOCUS make the greatest impact it can,” Ben-Zeev said.

The FOCUS app has written and video content adapted from in-person, evidence-based interventions. Its treatment domains address:

  • auditory hallucinations (“hearing voices”)
  • mood problems (typically depression and anxiety)
  • sleep
  • social functioning such as social skills training or paranoia
  • medication use (reminders and information to examine counter-therapeutic beliefs that people might have about their medications)

The App is Always Available

The app’s 24/7 availability is a huge advantage for patients who may have mental health needs outside clinic hours and who otherwise might need to wait several weeks or more to address an episode in a clinic environment. 

Moreover, many patients with serious mental illness receive services at community mental health centers. These facilities often are under-resourced and less able to provide continuity of care due to high turnover rates among their staff. FOCUS can provide continuity of care as clinical staffing ebbs and flows, Ben-Zeev said. 

The study will be conducted in collaboration with the adult outpatient programs at community mental health agencies in New Hampshire and Missouri that care for people with serious mental illness: 

Sources:

UW Medicine Newsroom

PCORI News

BRITE Center (Focus Developers)

Using Virtual Reality to Address Serious Mental Illness

OxfordVR Earns FDA’s Breakthrough Device Designation for its gameChange Treatment

Published in Lancet Psychiatry an automated virtual reality therapy program to treat agoraphobic avoidance and distress in patients with psychosis: a multicenter, parallel-group, single-blind, randomized, controlled trial in England was granted FDA’s Breakthrough Device Designation.

Oxford VR develops clinically validated, cost-effective, user-centred cognitive treatments for clinical conditions with significant impact on patients and the healthcare system.

Oxford VR’s developers are drawn from the gaming industry. They apply their animation, illustration and programming skills to help ensure the treatments are not only effective, but also engaging and easy to use. Each VR treatment uses high-quality simulations that promote the best clinical experience.

The Study

The clinical study assessed automated virtual reality therapy to treat agoraphobic avoidance and distress in patients with psychosis. It was a parallel-group, single-blind, randomized, controlled trial across nine National Health Service trusts in England. Eligible patients were aged 16 years or older, with a clinical diagnosis of a schizophrenia spectrum disorder or an affective diagnosis with psychotic symptoms, and had self-reported difficulties going outside due to anxiety. Patients were randomly assigned (1:1) to either gameChange VR therapy plus usual care or usual care alone. gameChange VR therapy was provided in approximately six sessions over 6 weeks. Trial assessors were masked to group allocation. Outcomes were assessed at 0, 6 (primary endpoint), and 26 weeks after randomization. The primary outcome was avoidance of, and distress in, everyday situations, assessed using the self-reported Oxford Agoraphobic Avoidance Scale (O-AS).

Results

A total of 346 were enrolled. 231 (67%) patients were men and 111 (32%) were women, 294 (85%) were White, and the mean age was 37·2 years (SD 12·5). 174 patients were randomly assigned to the gameChange VR therapy group and 172 to the usual care alone group. Compared with the usual care alone group, the gameChange VR therapy group had significant reductions in agoraphobic avoidance at 6 weeks.

Reductions in threat cognitions and within-situation defense behaviors mediated treatment outcomes. The greater the severity of anxious fears and avoidance, the greater the treatment benefits. There was no significant difference in the occurrence of serious adverse events between the gameChange VR therapy group (12 events in nine patients) and the usual care alone group (eight events in seven patients; p=0·37).

Automated VR therapy led to significant reductions in anxious avoidance of, and distress in, everyday situations compared with usual care alone. gameChange VR therapy has the potential to increase the provision of effective psychological therapy for psychosis, particularly for patients who find it difficult to leave their home, visit local amenities, or use public transport.

Sources:

Freeman D, Lambe S, Kabir T, et al. Automated virtual reality therapy to treat agoraphobic avoidance and distress in patients with psychosis (gameChange): a multicentre, parallel-group, single-blind, randomised, controlled trial in England with mediation and moderation analyses. Lancet Psychiatry 2022; 9: 375–88.Published Online. April 5, 2022. https://doi.org/10.1016/ S2215-0366(22)00060-8 

OxfordVR website

GamechangeVR website